Assessment of the Eye,Ear,Nose,Mouth and Throat

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Assessment of the Eye,Ear,Nose,Mouth and Throat

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• (?)Eyesensory organ 1.External Anatomy
• .Structure
• .Gland
• meibomian gland
• Lacrimal gland
• . tears pathway
• .Muscular
• Extraocular muscular conjugate movement
• . nerves control

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• 2.Internal Anatomy
• .Outer layer sclera / cornea
• . Corneal reflex afferent n (CNV) /
  efferent n (CNVII)
• .Middle layer choroid
• . vascular pigment
• . muscular fiber pupil
• . Lens
• .Inner layer retina (visual receptor)
• . nerve optic disc (optic papilla)
• . vessel artery / vein
• . Macula / Fovea centralize

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• (?)Ears
• 1.Exteranl Ear
• . external auditory canal 1/3 catilage /
  2/3 bone S-curve
• . Tympanic membrane (eardrum )
• 2.Middle Ear
• . ear bone malleus ? Bincus ? Bstapes
• . Eustachian tube conduct / protect /
  equalize

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• 3.Inner Ear
• . bony labyrinth equilibrium / hearing
• semicircular canals / vestibule
• 4.Fuction
• hearing and equilibrium

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• (?)Nose
• 1.Bone
• .Superior turbinate
• . Middle turbinate
• . Inferior turbinate
• 2.Mucosa / Vibrissae
• 3.Sinuses
• . Frontal sinuses .
  Maxillary sinuses
• . Ethmoid sinuses .
  Sphenoid sinuses

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• (?)Mouth and Throat
• 1.Bone
• . Hard plate
  . Soft plate
• 2.Mucous
• 3.Gland
• . Partied gland
• . Submandibular gland
• . Sublingual gland
• 4.Teeth
• 5.Tonsillar
• 6.Throat

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• (?)Eyes
• 1.Visual pathway
• light (object)?cornea?aqueous
• ?humor?lens?vitreous body
• ? retina ? optic nerve( CNII )
• ? occipital lobe cortex

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• .image formed
• temporal visual field ?
• nasal area retina
• .optic chiasm
• nasal fiber ? both temporal visual
• field

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• 2.Visual reflexes
• (1) Pupillary light reflex
• subcortical reflex arc
• ? afferent nerve ? CNII(optic nerve)
• ?efferent nerve ? CNIII(oculomotor nerve)
• . direct light reflex
• . consensual light reflex

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• 2.Visual reflexes
• (2) Fixation
• strong conscious control ?fix image to fovea
  centralize
• (3) Accommodation
• eyeball convergence and pupillary constriction

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• (?)Ears
• 1.Hearing
• Noise?Tympanic membrane?ear bone?oval
• window?cochlea?round window?basilar
• membrane ? Cortic organ(hair cells)
• ? CNVIII ? temporal lobe cortex

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• 2. Hearing pathway
• .Air conduction(AC)
• .Bone conduction(BC)
• 3.Hearing loss
• ?conductive loss
• mechanical dysfunction of external or
  middle ear
• ?sensorineural loss
• inner ear , CNVIII , auditory area
  cortex damage
• ?mixed loss

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• (?)Nose
• 1.Smelling
• Smell?olfactory receptor (hair cells )
• nasal cavity roof and upper 1/3 nasal
• septum ? CNI ?temporal lobe

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• (?)Mouth
• 1.Taste
• Tongue
• sweet
• salt
• sour
• bitter

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• Eyes ( Inspect )
• ?External Ocular Structures
• 1).General
• move around the room
• 2).Eyebrows
• bilaterally symmetrically scare
  lesion

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• 3).Eyelids and Lashes
• no redness swelling discharge
• upper lids ?overlap the superior part of
  the
• iris
• 4).Eyeballs
• no protrusion or sunken

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• 5).Conjunctiva and Sclera
• moist / glossy / color
• 6).Lacrimal apparatus
• Inspect / pressing

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?Anterior Eyeball Structure

• 1).Cornea and Lens
• smooth / clarity(oblique view)
• 2).Iris and Pupil
• flat / round regular shape / color / equal
  size
• pupillary light reflex (pupils rest
  size35mm)
• . direct light reflexconstruct of the same
  sided pupil
• . consensual light reflexconstruct the
  other pupil
• . accommodation pupillary construction and
  convergence
• eyes
  axes

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?The Ocular Fundus

• 1).Inspect
• optic disc / retinal vessel /general
  background / macula
• 2).Optic disc
• locate on nasal side of retina ?disc
  diameter (DD)?
• color / shape / margins / cup-disc ratio
• 3).Retinal vessels
• 4).Macula locate on temporal side of
  retina(1DD)

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? Snellen Eye Chart ( Near Vision )

• .place at eye level
• .20 feet from chart hold the card about 35
  cm
• .normal visual 20/20 ( 14/14 )
• ? Visual field
• .Confrontation Test
• . eye level with person about 2 ft
• . cover the same eyes
• . each eyes test 6 range of peripheral
  vision

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?Extraocular Muscle Function

• 1).Corneal Light Reflex
• . assess the parallel alignment of eye axes
• . light about 30 cm on the corneas
• if asymmetry of the light ? Cover test
• 2).Cover test
• . interrupt the two eyes parallel to
  detect small degree
• of deviated alignment
• ? Phoria ?? Tropia
• 3).Diagnostic Positions Test
• . six cardinal position .
  distance 12 inch

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Ears (Inspect and Palpate)

• ?The External Ear
• 1).Size and shape
• bilaterally equal size , no swelling ,
  thickening
• 2).Skin condition
• intact , no lump or lesion
• 3).Tenderness
• move the pinna and push the tragus
• 4).The external auditory meatus
• size / swelling / redness / discharge

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?The Otoscopic Examination

• 1).Using the Otoscope
• a. choose the largest speculum
• b. head toward the opposite shoulder
• c. pull adult ear pinna upper and back
• pull infant and child ( lt3 age ) pinna
  down

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?The Otoscopic Examination

• d. hold the otoscope upside down
• The External Canal
• redness / swelling / lesion / foreign
  body / discharge
• Tympanic Membrane
• color / character / perforation
• shiny , translucent , pearl-gray color
• Cone-shaped light reflex
• visible Umbo Manubrium short
  process

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Hearing Acuity

• (1) Voice Test
• . test one ear at a time
• . 30 60 cm whisper slowly
• ? unable to hear whisper ? high tone loss

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(2) Tuning Fork Test

• Weber test
• .place a vibrating tuning fork in the midline
  skull
• .the same sound in both ears
• Rinne test
• .compares air conduction ( AC ) and bone
  conduction( BC )
• .mastoid ? near ear cana
• .AC BC? 2 1 or(AC gt BC)

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• ????
• Hearing loss Webber test Rinne test
• Conductive loss ????????
  ACltBC
• Sensorineural loss ???????? ACgtBC

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Nose ( Inspect and Palpate )

• ? Eternal Nose
• 1).symmetric , in the midline , skin lesion ,
• pain
• 2).nastril patency
• each time test one nasal (CNI)

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? Nasal Cavity

• 1).nasal speculum insert 1 cm
• 2).short wide-tipped speculum
• . normal red color and smooth moist surface
• . note swelling , discharge , bleeding ,
  foreign
• body
• . nasal septum deviation
• . turbinate middle and inferior (red
  color)

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? Sinus Areas

• Palpate
• 1).frontal sinus? below the eyebrow
• 2).maxillary sinus ? below cheekbones
• ? chronic allergy and acute infection
  (sinusitis) ? pain
• TransilluminationR/O sinusitits
• 1).frontal sinus ? under thesuperior orbital
• 2).maxillary sinus ? inside the mouth on the
  hard palate
• normal ? light up symmetrically

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Mouth (Inspect and Palate)

• ? Mucosa
• 1).lip
• color , moisture , crack , lesion
• 2).Teeth and Gums
• teeth number and alignment / gum color ,
  bleeding , swelling
• 3).Tongue
• color , surface character , moisture ,
  nodule, ulcer , lesion

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Mouth (Inspect and Palate)

• 4).Buccal Mucosa
• color , nodule , lesion
• ? Stensens duct ? open the parotid
  salivary(upper
• second molar)
• 5).Palate
• pink , smooth , upwardly movable
• . uvula in the midline (CN X)

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?Throat (Inspect and Palate)

• 1).Tonsils
• color , small plugs , size
• Tonsils grade (p.395)
• 1 visible
• 2 halfway between tonsillar
  pillars and uvula
• 3 touching the uvula
• 4 touching each other
• (2 , 3 , 4 ? Acute Infection)